What is Kyphosis?

Kyphosis is an excessive forward curvature of the spine. It is often seen as a rounded upper back, forward-bent posture, or “hunched” appearance. A normal spine has natural curves, but kyphosis refers to a curve that is greater than expected or that causes symptoms, imbalance, or structural concern.

Kyphosis most commonly involves the thoracic spine, which is the mid back, but abnormal forward curvature can also affect the cervical or lumbar spine in selected cases. Kyphosis may be postural, meaning related to posture and muscle control, or structural, meaning related to changes in the vertebrae, discs, joints, fractures, prior surgery, or deformity.

De Novo Brain & Spine evaluates adult patients with kyphosis when symptoms suggest spinal deformity, back pain, nerve compression, spinal cord compression, vertebral compression fractures, spinal instability, progressive posture change, or another spine-related condition that may require neurosurgical review.

Common Signs and Symptoms

Kyphosis symptoms depend on the size and location of the curve, spinal balance, flexibility, underlying cause, and whether nerves or the spinal cord are affected.

Common signs and symptoms may include:

• Rounded upper back or forward-bent posture
• Visible hump or increased curvature in the mid back
• Back pain or stiffness
• Muscle fatigue or aching in the back
• Difficulty standing upright
• Pain that worsens with prolonged standing, walking, lifting, or activity
• Tightness in the chest, shoulders, hamstrings, or back muscles
• Reduced spinal flexibility
• Trouble with posture or balance
• Height loss in patients with vertebral compression fractures
• Pain after a fall or minor trauma, especially in patients with osteoporosis
• Numbness, tingling, or weakness if nerve compression is present
• Trouble walking, balance problems, or coordination changes if the spinal cord is affected
• Shortness of breath or reduced activity tolerance in selected severe spinal deformity cases

Seek urgent medical evaluation for kyphosis with progressive weakness, worsening numbness, trouble walking, loss of coordination, bowel or bladder changes, severe pain after trauma, fever, unexplained weight loss, history of cancer, or rapidly worsening neurological symptoms. Seek emergency medical care or call 911 for sudden weakness, sudden speech difficulty, loss of consciousness, chest pain, severe shortness of breath, or symptoms that may suggest a stroke, heart-related emergency, or serious traumatic injury.

What Causes This Condition?

Kyphosis can develop for different reasons. Some forms are flexible and related to posture, while others are structural and related to changes in the bones, discs, joints, ligaments, or alignment of the spine.

Possible causes and related conditions may include:

• Postural kyphosis, often related to posture, muscle weakness, or poor spinal support
• Scheuermann’s kyphosis, a structural kyphosis that begins during growth and may persist into adulthood
• Adult degenerative kyphosis, related to age-related disc, joint, and spinal alignment changes
• Osteoporotic vertebral compression fractures, which can cause wedge-shaped vertebrae and forward curvature
• Traumatic spinal fractures
• Degenerative disc disease
• Facet joint disease or spinal arthritis
• Spondylosis, meaning degenerative arthritis of the spine
• Spinal instability
• Scoliosis or other spinal deformity
• Prior spine surgery in selected patients
• Congenital spinal formation differences, meaning structural changes present from development
• Neuromuscular conditions in selected cases
• Spinal tumor, infection, inflammatory disease, or metabolic bone disease in less common cases

These causes and risk factors do not mean every patient with kyphosis will have pain or need surgery. Treatment planning depends on the type of kyphosis, curve size, spinal balance, symptoms, neurological examination, bone health, imaging findings, and overall health.

How It Is Diagnosed?

Kyphosis is diagnosed through medical history, physical examination, neurological examination, and imaging. Imaging helps measure the spinal curve, evaluate alignment, and determine whether fractures, nerve compression, spinal cord compression, or instability are present.

Common diagnostic steps may include:

• Medical history and symptom review to understand posture changes, back pain, stiffness, walking tolerance, injury history, prior fractures, prior spine surgery, and red-flag symptoms
• Physical examination to evaluate spinal posture, curve flexibility, shoulder position, trunk alignment, gait, tenderness, and painful movement
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, balance, and signs of nerve root or spinal cord involvement
• Standing spine X-rays to measure the kyphosis curve and evaluate spinal alignment
• Cobb angle measurement to quantify the degree of spinal curvature
• Standing scoliosis or full-spine X-rays to evaluate sagittal balance, coronal balance, pelvic alignment, and overall spinal posture
• Flexion-extension X-rays in selected cases when abnormal motion or spinal instability is suspected
• MRI of the cervical, thoracic, or lumbar spine when nerve compression, spinal cord compression, disc disease, tumor, infection, fracture, or neurological symptoms are suspected
• CT scan when bone detail, fracture pattern, deformity, prior fusion, or surgical planning requires further evaluation
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal canal and nerve roots is needed
• Bone density testing when osteoporosis or fracture risk may affect treatment planning
• Blood tests in selected cases when infection, inflammatory disease, metabolic bone disease, or cancer-related concern is suspected
• Electromyography and nerve conduction studies, also called EMG/NCS, when symptoms may overlap with radiculopathy, peripheral neuropathy, or another nerve disorder

The goal of diagnosis is to determine the type and severity of kyphosis, identify whether the curve is flexible or structural, evaluate spinal balance, and decide whether monitoring, conservative care, fracture treatment, or surgical evaluation may be appropriate.

Treatment Options

Kyphosis treatment depends on the cause, curve size, curve flexibility, symptoms, spinal balance, neurological examination, bone health, imaging findings, prior treatment, activity limitations, and overall health. Not every patient with kyphosis needs surgery.

Treatment options may include:

• Observation with repeat imaging for selected mild, stable, or minimally symptomatic curves
• Posture education and activity modification when posture or daily movement patterns contribute to symptoms
• Physical therapy to improve posture, spinal extension strength, core strength, flexibility, balance, and walking mechanics
• Home exercise and stretching when recommended by a clinician or therapist
• Treatment of osteoporosis or bone health concerns when vertebral compression fractures or fracture risk are present
• Heat, ice, or other comfort measures for short-term symptom relief
• Anti-inflammatory medication, acetaminophen, muscle relaxants, or nerve pain medication when medically appropriate
• Bracing in selected cases when temporary support or curve management is appropriate
• Pain management options, such as injections, when facet joint pain, nerve irritation, or overlapping spine conditions contribute to symptoms
• Treatment of vertebral compression fractures in selected cases, which may include medication, bracing, osteoporosis care, rehabilitation, or procedural treatment when appropriate
• Spinal decompression in selected cases when nerve compression or spinal cord compression is a major source of symptoms
• Spinal fusion or deformity correction in selected cases involving severe or progressive kyphosis, spinal imbalance, neurological symptoms, instability, fracture-related deformity, or disabling symptoms that do not improve with appropriate non-surgical care
• Revision spine surgery in selected patients with post-surgical kyphosis, pseudoarthrosis, adjacent segment disease, hardware-related concerns, or recurrent deformity
• Rehabilitation and follow-up care to monitor pain, posture, alignment, strength, walking, function, and neurological status

Surgery is not appropriate for every patient with kyphosis. Neurosurgical treatment may be considered when kyphosis causes significant spinal imbalance, progressive deformity, nerve compression, spinal cord compression, spinal instability, fracture-related deformity, severe pain, or symptoms that do not improve with appropriate non-surgical care.